Cognitive Behavioral Therapy (CBT) Flashcards
disroders CBT is used to treat
- Eating disorders
- Major depressive disorder, bipolar disorder
- Anxiety disorders (panic, agoraphobia, GAD, social phobia, simple phobias, OCD, PTSD)
- Residual + symptoms of schizophrenia
- Borderline personality disorder (DBT)
- Sleep disturbance
- Anger reduction
- Medication adherence
what aspects of eating disorders does CBT treat?
(anorexia nervosa, bulimia nervosa, binge-eating disorder, night eating syndrome, obesity [behavioral aspects])
main assumption of CBT
thoughts, feelings, and behaviors are interconnected
respondent conditioning is the same as __/__ conditioning
respondent conditioning is the same as classical/Pavlovian conditioning
in respondent conditioning, __ controls __ behavior
in respondent conditioning, antecedents controls involuntary behavior
respondent conditioning buids on __ connections
respondent conditioning buids on innate stimulus-response connections
respondent conditioning example
Pavlov’s dog
being afraid the moment before lightning hits
instrumental conditioning aka __ conditioning
instrumental conditioning aka operant conditioning
instrumental conditioning builds on
innately rewarding or punishing value
reinforcements __ likelihood of repeating behavior
punishments __ likelihood of repeating behavior
reinforcements increase likelihood of repeating behavior
punishments decrease likelihood of repeating behavior
instrumental conditioning
postive = stimulus __
negative = stimulus __
instrumental conditioning
postive = stimulus present
negative = stimulus removed
instumental conditioning: stimulus response/habit learning: after repetition in given context, __ re-assume control
instumental conditioning: after repetition in given context, antecedents re-assume control
Classical (respondent) conditioning:
Pavlov’s dog
unconditioned stimulus
unconditioned response
neutral stimulus
conditioned stimulus
conditioned response
Pavlov’s dog
unconditioned stimulus: food
unconditioned response: salivation
neutral stimulus: tuning fork
conditioned stimulus: tuning fork
conditioned response: salivation
operant (instrumental) conditioning
good grades example
positive reinforcement
positive punishment (type 1 punishment)
negative reinforcement
negative punishment (type 2 punishment)
operant (instrumental) conditioning
good grades example
positive reinforcement: reward (good grades)
positive punishment (type 1 punishment): after school detention
negative reinforcement: escape (excused from chores)
negative punishment (type 2 punishment): no TV for a week
habit learning
with enough repeitition, the behavior persists even without the stimulus
caution for conditioning
it is good for __ but not for __
caution for conditioning
it is good for behaviors but not for illness
CBT flow chart
- antecedents/circumstances (stimuli)
- thoughts + feelings
- behavior
- consequences (influence behavior)
circumstances: I was sticking to my diet and losing weight every week, and now the weight loss has stopped
what are potential interpretations
- It’s my fault. I must be doing something wrong.
- If I try harder or do something different, I can keep losing.
- Maybe I’ve lost enough weight already.
- It’s the program’s fault – I’m doing my part and I’m not getting the response I deserve.
- I’ve been here before. Now I am just going to regain all the weight I’ve lost and more.
automatic thoughts
right below the surface
takes effort to bring them to the surface
automatic thoughts often reflect __
automatic thoughts often reflect cognitive distortions
cognitive distortions
shortcuts we take to process the world’s complexities
sometimes are a problem
automatic thoughts are not usually __
automatic thoughts are not usually logical
where do automatic thoughts come from
core beliefs
core beliefs
basic mindsets or world views
laid down early in life
influenced by our innate temperament
intermediate/conditional belief
“if i study enough I’ll do better than everybody”
holds off a core belief of
inadequacy
intermediate/conditional beleif
“if i’m thin enough people will accept me”
holds off a core belief of
unlovability
we use intermediate/conditional beliefs to __
we use intermediate/conditional beliefs to keep painful core beliefs away
CBT: 10 general process features of treatment
- collaborative/teaching and learning
- time limited
- set structure and duration
- explicit consensual goals
- problem oriented
- here and now focus
- homework/reinforcement
- patient as her/his own therapist
- autonomy vs. non-negotiables
- meds/attribution
goal of CBT
patient becomes their own therapist and can manage their condition going forward
example of non-negotiable in anorexia treatment
if your weight drops below a certain point, you will have to seek more intense treatment
why is attribution important when meds are involved?
patients may attribute all progress to meds and not understand the interplay of CBT and medications
CBT: general content features of treatment
- shared cognitive-behavioral model
- psychoeducation regarding the disorder
- self-monitoring
- motivation/decision analysis
- cognitive restructuring
- systematic problem solving
- behavioral experimentation/exposure
- relaxation and mindfulness
- relapse prevention/continued progress plan
- shared cognitive behavioral model: sharon, bulimia nervosa
- low self-esteem
- extreme concerns about shape and weight
- rigid dietary rules/strict dieting
- binge eating/overeating
- purging
her mood and stress impacts all of these
2 psychoeducation for bulimia nervosa
vomiting and laxative abuse
redistribution of calories
3 self-monitoring
keeping a record
4 motivation/decision analysis
each choice has __ and __ pros and cons
each choice has immediate and delayed pros and cons
immediate pros of stopping bingeing
Will feel I’m doing the right thing. Doctor will be pleased.
immediate cons of stopping bingeing
Will be anxious about gaining weight. Will have to give up many foods. Will not have the release of B/V.
delayed pros of stopping bingeing
Better health. Less isolation and secrecy.
delayed cons of stopping bingeing
Will need to develop other coping mechanisms.
immediate pros of continunig bingeing for now
Will still have the comfort of B/V. Won’t get fat.
immediate cons of continuing bingeing for now
Friends might find out. Will still need to find a way to vomit if I eat too much.
delayed pros of continuing bingeing for now
Maybe it will be easier to stop after I finish college.
delayed cons of continuing bingeing for now
It may get harder to stop the longer I go on. I may develop more dental problems if I don’t stop pretty soon.
5 cognitive restructuring for sharon
articulate the __ and __
5 cognitive restructuring for sharon
articulate the circumstances and feelings
Circumstances: My therapist is recommending that I change my pattern of eating.
Interpretation:
Interpretation:
If I eat three meals a day, I will gain a ton of weight.
If I eat a “normal meal,” I’ll feel uncomfortably full, and I’ll have to vomit.
If I let myself eat normally, I’ll never stop eating.
This recommendation is fine for other people, but my body is different and it will never work for me.
4 steps of cognitive restructuring
- articulate the circumstances and feelings
- identify the core thought
- critically examine the thought
- reach a reasoned conclusion which is more accurate and more useful (rate effects on feelings and behavior)
are automatic thoughts always bad?
no sometimes they are shortcuts in getting work done
typical cognitive distortions
Dichotomous, all-or-nothing thinking
Arbitrary inference (“jumping to conclusions”)
Overgeneralization
Labeling and emotional reasoning
Personalization
Magnification and minimization
Selective abstraction or mental filter
“Should” statements
hot thought for sharon
I’m fat → john was talking to jen → he won’t talk to me because i’m so fat → john thinks im fat, disgusting, and pathetic (95%)
testing the thought
evidence for
evidence against
alternative view
effect of believing thought
effective of believing alternative
what you would tell a friend
Evidence For: He did not choose me to talk to. Jen is thinner than I am. My little brother Peter told me last summer that I looked fat.
Evidence Against: John is usually pretty friendly to me. He used to date Ann who is heavier than I am.
Alternative View: Maybe he’s waiting for me to approach him.
Effect of believing thought: I will keep to myself
Effect of believing alternative: I will be more likely to talk to him
What you would tell a friend: Relax. Just because he’s talking to Jen doesn’t mean he doesn’t like you. You always think this, and it is usually not true.
6 systematic problem solving
- Write down the problem as precisely as possible and as soon as possible; if there’s more than one problem break them down
- Generate as many alternative solutions as possible
- List the pros and cons of each solution as a means of evaluating the effectiveness and feasibility of each solution
- Choose a solution
- Implement the solution
- Evaluate the result; if the problem is not resolved, return to Step 4
7 behavioral experimentation/exposure
Stimulus Control: Identification of High Risk Situations
Systematic Delay
Use of Situation-Specific Alternatives: Reinforcement of Normal Eating
Graded Exposure to Feared Foods
which step uses stimulus control
step 7
stimulus control techniques are __
stimulus control techniques are individual
stimulus control for sharon
Do nothing else while eating
Confine eating to one place
Limit available food while eating
Leave food on plate
Discard leftovers
Slow eating (put fork down, pause)
Leave table after eating
Serve and eat one portion at a time
Shopping (planned, not when hungry)
Limit exposure to “danger” foods
graded exposure for sharon
- Go to grocery store, classify foods according to safeness-forbiddenness
- Assignments of gradually increasing difficulty (food, context)
- Eat food and do not compensate
- Review with therapist and come up with next assignment
graded exposure for sharon
- Go to grocery store, classify foods according to safeness-forbiddenness
- Assignments of gradually increasing difficulty (food, context)
- Eat food and do not compensate
- Review with therapist and come up with next assignment
7 behavioral experimentation/exposure includes __ and __
behavioral experimentation/exposure includes stimulus control and graded exposure
what type of analysis is useful in step 7
behavior chain analysis
step 8 is
relaxation and mindfulness
9 relapse prevention/continued progress plan
Discuss ongoing vulnerability and need for explicit plan to manage this
Design relapse prevention plan
Anticipate lapses and discuss coping strategies
Explore high risk situations which are likely to arise and strategies for managing these
Discuss issues surrounding termination
continued progress plan for sharon
Self-monitor on weekends
Make plans with friends (or plan a solo activity) Friday and Saturday evenings
Make time for exercise 3x/wk.
Check weight every Wednesday AM
Review my records Sunday evenings 7-8 PM
Do thought record whenever tempted to binge or purge
lapse contingency plan for sharon
Plan all meals and snacks
Self-monitor daily
Do thought record at least 1x/day
Review my Decision Analysis and update
Tell Michelle (best friend) about it
Call therapist if it lasts for > 1 week
plan for high risk situation for sharon
visiting parents on weekends is high risk
avoid this, educated parents on the issue
CBT: it is very hard to change how you __, but with practice it is possible to change how you __ and what you __
CBT: it is very hard to change how you feel, but with practice it is possible to change how you think and what you do
CBT: it is very hard to change how you __, but with practice it is possible to change how you __ and what you __
CBT: it is very hard to change how you feel, but with practice it is possible to change how you think and what you do
content features of CBT: psychoeducation
the genetic/environmental causes of obesity, the “fight-flight-freeze” response in anxiety disorders
content features of CBT:
self-monitoring of behavior
(eating, exercise), feelings, thoughts, patient learning how to identify the A, B, and C’s
content features of CBT:
motivation
in CBT, thought to wax and wane throughout treatment–Decision analysis, is this the right time to be working on this? What are the pros/cons of change as well as the pros/cons of status quo?
content features of CBT:
cognitive-behavioral model
collaboratively developed by patient and therapist, summarizing the major cognitive and behavioral mechanisms that maintain disorder. Roadmap for treatment.
content features of CBT: cognitive restructuring
systematically looking at automatic thoughts and associated feelings and behaviors, taking a step back from and reconsidering thoughts and coming up with more balanced and adaptive interpretation that influences feeling and behavior.
content features of CBT:
problem solving
straightforward process for dealing with problems that arise, the default solution to which is often a maladaptive behavior. Goal is to replace this reflex maladaptive behavior (e.g. avoidance, substance use, temper tantrum) with well-considered alternative.
content features of CBT:
experimentation
e.g. eating a forbidden food, having a difficult conversation. Scientific orientation – do experiments and gather data
content features of CBT: behavioral activation
scheduling pleasurable activities and engaging in them, even if you don’t feel like it at the time, then monitoring response. Useful in depression. Exposure: gradual exposure to feared situations without engaging in safety behaviors or compensatory behavior, e.g. OCD dirtying hands and not washing, looking out the window of a high floor without hanging on. Useful in anxiety disorders.
content features of CBT:
relaxation
focus on breathing, progressive muscle relaxation as a means of tolerating dysphoric states; NOT to be used in the service of emotional avoidance. Mindfulness: awareness and acceptance of dysphoric states; stepping back from and not being cognitively fused with or overwhelmed by these states.
content features of CBT:
relapse prevention/continued progress
Patient becoming own therapist Needs a plan for maintenance, further progress, lapse management, and dealing with high risk situations.
